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Paperwork Tteduction Act Notice
<br />~ Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to ] 10 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor fa=ilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining [he data needed, and completing and ~
<br />reviewing the collection of information. Send comments regazding the burden estimate or any other aspect of ~
<br />this collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the ~
<br />~ Office of Information and Regulatory Affairs, Offce of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially contple[ed by preprinting, disregard instructions directed at entry of that information
<br />already Preprinted.
<br />2. Enter 'Permittee Name,^.tlailing Address (and facility name location, if diH'erent)," "Permit Number." and
<br />"Discharge ,'Vumbei' where indicated. (A separate form is required Cor each discharge.)
<br />3. Enter dates beginning and ending "Afonrturing Period" covered by form vs here indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Afrasurenrenr" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is nornurll} arithmetic average (geometric average for bacteria] parameters) of all sample measrrcmen[s
<br />for each parameter ohtained during ".lfommring Period"; ".llazrmmn" and "rLfinirnu+n" are normally exvemc high
<br />and low measurements obtained during ".tlr.niturmg Period" (Note to municipals nnh secondary treatment
<br />requiremem: Enter 30<iay average of sample measurcmcnts under "Average," and enter maximum 7-day average
<br />of sample measurements obtained during monitoring period under "h4azimum.
<br />6. Emer "Pernnt Requrrernent" for each paramete: under "Quanrih" and "Quality" as specked m pcrnit.
<br />7. Under "No Er" enter number of sample measurnenrs during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency ojAnalysis" both as ".Sntn~le dleasurmenP' (actual frequency of sampling and analysis used
<br />during monitoring period) ar~d as "Fermi! RequiremenP' specified in permit. (c.g., Enter "Cant," for continuous
<br />monitoring, "I /7" for one day per week, "1/30" Cor one day per month, "//90" for one day per quarter, etc.)
<br />9. Enter "Sample Type" bosh as "Sample .lfeasuremen!" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "C;rab" for individual sample, "2~lHC' for 24-hour composite, ",L'/,t" for
<br />continuous monitoring, etc.)
<br />10. Where violations of perm[ requirements arc reported. attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />I I. If "no discharge" occurs during monitoring perod, enter "h'o Discharge" across form in place of data entry.
<br />12. Enter "Name/f'itle ojPrincrpa! Executive OJJ,cer" with "5'ignature ojPrincipn/ Executive Officer ojAutharized
<br />Agent," "Telephone Number," and "Dare" at bottom of form.
<br />13. Mail signed Repoli to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (D,41R) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 I.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
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